November 12, 2019

By Carolyn Yates, PT, DPT

Hey mama! You’re doing great and are on the homestretch now. Before you know it, that little bundle of joy will be snuggled up in your arms 🙌

Let’s be honest, childbearing is no walk in the park. It’s beautiful and natural of course, but it is also very intense. Your body goes through so many amazing changes to grow a new human. Unfortunately, the resources for preparing your body during pregnancy and for rehabilitating after labor and delivery are seriously lacking. Here are three easy exercises you can do right now to prep your body and reduce your chance of injury during labor and delivery.

Let’s get started!

Belly Breathing

• Practice belly breathing with (gentle) pelvic floor contractions and relaxations
  Picture your core like a soda can. The top is the diaphragm, the walls are your abdominal and back muscles and the bottom is the pelvic floor. It is a closed system which means you can create increases and decreases in pressure.
  
• When you take a breath in, your diaphragm lowers. This lowering increases the pressure in your abdominal cavity.
  • When you are up and moving around/exercising/picking things up off the floor, this increased pressure is resisted by your abdominals and pelvic floor contracting and helps to prevent injury.
  • When you are in a relaxed position (i.e., sitting comfortably, lying on your side) this increase in pressure can be released through the relaxation and expansion of your abdominals and pelvic floor muscles.
• When you exhale your air out of your lungs, your diaphragm raises back up into the relaxed position. This creates a negative pressure in the abdominal cavity and the belly comes back in and the pelvic floor raises up.
• So, in order to start bringing awareness to your pelvic floor and learning how to RELAX your pelvic floor down (which is what should be happening during delivery to allow baby to grace us with his/her presence), I recommend practicing belly breathing with an added awareness of the pelvic floor.
• Deep breath in:
  • Belly should rise
  • Pelvic floor should relax and lower or “bulge” out slightly
• Exhale air out:
  • Belly should lower back down
  • Pelvic floor should contract up

Deep squat stretch

• This is a great position to get in to open up your hips and really FEEL your pelvic floor!
• Make sure your toes are pointing out, your feet are wider than hip width, and your heels are down on the floor
• If this is a difficult position to get in to due to hip or knee discomfort, use a yoga block or small stool to sit on. Your hips should be below your knees and you should be trying to feel a deep stretch but relax into the position at the same time.
• In this position, try using the belly breathing technique described above to engage and relax your pelvic floor
• Work up to 3 sets of 30-60 second holds down in this position

Self-internal release

• To prepare your perineum for the stretching that will happen as baby comes into this world, I recommend doing some self release of the pelvic floor. A gentle stretch just like you would stretch your hamstrings...except I do recommend being somewhere private, like the shower, for this stretch...public nudity is unfortunately frowned upon in our society ;)
• So, while you’re naked, prop one foot up onto something STURDY, insert the opposite thumb superficially into the vagina and apply a gentle down-and-out stretch to the skin and muscles. You should be pushing towards your sit bones. Hold that stretch for 30-60 seconds and then switch sides.
• You can also do a nice sweeping/stretch motion with your thumb in that position.
• This should be a gentle stretch and you should be focusing on relaxing your pelvic floor as you perform the release.

Does self-internal release really work?

Studies have shown that doing self-release work 1-2 times per week can help reduce the likelihood of trauma caused to the perineum as well as ongoing perineal pain postpartum.

Why am I not just doing Kegels?

Kegels are great but they are not the end-all-be-all pelvic floor exercise. It is equally as important to stretch and relax your muscles as it is to strengthen them. Belly breathing incorporates strengthening as well as relaxation and lengthening of the muscles that many people forget to stretch! Preparing your muscles for labor and delivery through belly breathing work can potentially help shorten the first and second stages of labor as well as reduce the likelihood of having urinary incontinence during pregnancy and postpartum.

Take a moment to think about what your body is doing. It really is spectacular! You are doing great! Labor and delivery will be intense; no sugar-coating here. However, these three simple exercises can help prepare your body and prevent injuries during birth. If you are reading this and are really confused, then please reach out to your local pelvic floor specialist and make an appointment. Your body and future self will thank you!

Sources:

Seehusen, D. A., & Raleigh, M. (2004). Antenatal perineal massage to prevent birth trauma. American Family Physician, 89(5), 335-336.

Bø, K., Hilde, G., Jensen, J. S., Siafarikas, F., & Engh, M. E. (2013) Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women. International Urogynecology Journal, 24(12), 2065-2070.

Boyle, R., Hay-Smith, E. J., Cody, J. D., & Mørkved, S. (2012). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews, 10, CD007471.

Prince, N., Dawood, R., & Jackson, S. R. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas, 67(4), 309–315.

Carolyn Yates, PT, DPT is a Colorado State licensed Physical Therapist with a pelvic floor rehabilitation specialty. She received a Doctorate of Physical Therapy (DPT) from Belmont University School of Physical Therapy and is the owner and head physical therapist of Verity Physical Therapy & Wellness in Boulder, CO.